CVD Surveillance System toward prevention

A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease

David C. Goff, Jr, MD, PhD; Lawrence Brass, MD†; Lynne T. Braun, PhD, RN, CNP; Janet B. Croft, PhD; Judd D. Flesch; Francis G.R. Fowkes, MD, PhD; Yuling Hong, MD, PhD; Virginia Howard, MSPH; Sara Huston, PhD; Stephen F. Jencks, MD, MPH; Russell Luepker, MD, MS; Teri Manolio, MD, PhD; Christopher O’Donnell, MD, MPH; Rose Marie Robertson, MD; Wayne Rosamond, PhD; John Rumsfeld, MD, PhD; Stephen Sidney, MD, MPH; Zhi Jie Zheng, MD, PhD
A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive
and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations
for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.
Overarching Recommendations
1. A National Heart Disease and Stroke Surveillance unit should be established to produce annual reports on key indicators of progress in the prevention and management of heart disease and stroke. P I, S I, C $.
2. Cardiovascular disease (CVD), including cardiac arrests, acute coronary syndromes (heart attack and unstable angina), stroke, chronic heart failure (CHF), and related interventional procedures, should be classified as reportable conditions. P I, S III (although developmental
work should begin earlier), C $$$.
3. Data collection about patients’ encounters with the healthcare system should be revised to include collection of data on lipoprotein cholesterol concentrations, blood sugar, and glycohemoglobin values. P I, S I, C $.
4. Data elements should be standardized across surveys, and unnecessary duplication in data sources should be avoided. P I, S I, C $ (potentially cost saving).
5. The design and conduct of nationally representative surveillance programs should be revised to facilitate oversampling by states, territories, and tribal organizations and to provide meaningful estimates on ethnic subgroups in the populations. Sampling within states, territories, and tribal organizations should be designed to facilitate oversampling by counties. P I, S
II, C $$ to $$$ (depending on extent of oversampling achieved).
6. Mechanisms should be developed to enable linkage between healthcare data systems, including the national surveillance programs (eg, National Ambulatory Medical Care Survey [NAMCS], National Hospital Discharge Survey [NHDS], and National Death Index), and
electronic health records. P I, S II, C $$$ (startup) and $$ (maintenance).
7. Studies are needed to establish the validity of multiple measures collected by self-report and provider report in national databases. P II, S II, C $$.